Provider Demographics
NPI:1861126930
Name:DRIVER, ADDORIA (MFT)
Entity type:Individual
Prefix:
First Name:ADDORIA
Middle Name:
Last Name:DRIVER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:DORRI
Other - Middle Name:
Other - Last Name:DRIVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16655 THORNTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2843
Mailing Address - Country:US
Mailing Address - Phone:708-752-3698
Mailing Address - Fax:
Practice Address - Street 1:16655 THORNTON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2843
Practice Address - Country:US
Practice Address - Phone:708-752-3698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208.000973106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist